Estimated time to read: 3 minutes

Let's be honest—committees get a bad rap. Some people love them (maybe a little too much), most people dread them. But here's the thing: when it comes to NCQA Accreditation, they're not optional.

The good news? A clear committee structure can actually transform them from a dreaded obligation into something that drives real quality and compliance.

With defined charters, the right people in the room, and clear reporting lines, your organization can make timely decisions, demonstrate compliance, and actually improve outcomes.

Let's talk about how to make that happen.

Why Committees Actually Matter

Look, we get it—another meeting feels like the last thing anyone needs.

But a strong committee structure does something important.

It:

• Gets different disciplines talking to each other and sharing their points of view for the subjects instead of working in silos
•  Supports your accreditation in ways that show up during surveys
•  Creates real accountability through clearly defined roles
•  Strengthens both decision-making and outcomes

Understanding the Accreditation Committee Structure

Think of your committee structure as the nervous system of your organization. It's how information, data, and strategic direction flow to your teams and leadership.

And those committee meeting minutes? They're not just busy work—they're the documentation that proves your organizational decisions actually happened and the specific date thereof.

Your committee structure and committee minutes are submitted with your NCQA survey submission, so it matters.

Example: Your Behavioral Health Practitioner Committee feeds information to both the Medical Policy and Quality Committees about evidence-based practices. That information shapes your criteria and drives initiatives to improve quality. See how it connects?

Start with a Governance Map

Before you dive into charters and bylaws, sketch out a simple flow chart that shows:

•  Each committee and subcommittee you have
•  Who they report to
•  What they approve versus just recommend

At the top, you've got two key players:

• Governing Board – This is your final authority for quality. They approve the QI Program Description and Annual Evaluation. (Although evidence of submitting the documentation to the Governing Board has not been required by NCQA for many, many years, they have a fiduciary responsibility for what occurs in the organization and need to know what is occurring.)
• Quality Improvement Committee (QIC) – They oversee the actual QI Program, including the Annual Work Plan and Evaluation. Their approval dates are what are the anchors for the “annual” requirements of 12 – 14 months.

Below that, you'll have committees that do the deep-dive work, run the analysis, make recommendations, and then report back up to the QIC.

The usual suspects include:

•  Utilization Management (UM)
•  Credentialing (CR)
•  Pharmacy & Therapeutics (P&T)
•  Population Health Management (PHM)
•  Member Experience (ME)
•  Grievance & Appeals (G&A)
•  Data Governance & Analytics

Now, here's where you have some flexibility. Depending on your size and product lines (Medicare, Medicaid, Commercial, Exchange), you might merge committees or split them up differently. National health plans sometimes add regional reporting layers. There's no single "right" structure—just the one that works for your organization and that meets the intent of the standards.

Write Strong Charters (Yes, Really)

Once you've mapped out your structure, it's time to develop charters. Think of a charter as the job description for each committee. It tells members why they exist, what they own, and how decisions get made.

Best practice? Have your QIC approve all charters. That creates clear accountability right from the start.

What goes in each charter:

• Name, Purpose, Authority – Be crystal clear about who granted the authority (QIC or Board).
• Scope of Work – What are they responsible for? What's explicitly not their job?
• Membership & Attendance – Who sits at the table? What are their roles, voting rights, and credentials? Which practitioners are required?
• Quorum & Voting – How many people need to show up for decisions to count? Some organizations use "more than 50% of members, including at least one physician."
• Decision Rights & Escalation – What can this committee approve on their own versus what needs to go up the chain to QIC or the Board?
• Meeting Cadence – How often do they meet? This should align with NCQA look-back periods and annual reporting requirements.
• Agenda & Materials – What reports and standard items show up every time?
• Minutes & Documentation – How do you track attendance, votes, follow-up, and audits?

Build Your Runway

If you're starting from scratch, here's a realistic rollout plan:

Days 1–30

•  Obtain governance map approval
•  Draft your charters
•  Nominate chairs and members
•  Create an annual meeting plan
•  Adopt a standard meeting minutes template

Days 31–60

•  Launch your QIC and key subcommittees (UM, CR, P&T)
•  Build in delegated oversight where it's needed

Days 61–90

•  Expand other committees and subcommittees based on what you learned

Days 91–120

•  Run mini-audits on your documentation and minutes to make sure you're actually meeting compliance requirements

Embrace Best Practices

What Separates Committees That Work from Committees That Waste Time:

•  Use an annual committee calendar. Make sure reviews of key issues, reports, and data happen on schedule so you're always survey-ready.
•  Send agendas and reports 3–5 days before meetings. Nobody likes surprises, and prep time makes better decisions. Let committee members know when to expect it and keep to the schedule no matter what. If you desire meaningful input, give them time to read and think. And on that note, cue up for each agenda item what is needed. FYI? Discussion? Decisions on initiatives? Determination of monitoring metrics? And by the way (and I’ve seen this far too many times), make sure that everything is not just ‘FYI’; the standards require acceptance and approval, such as with the evaluation and work plans.

•  Provide an executive summary for every report. Members are busy and do not have time to read five documents of monumental length. They can always dig deeper if they have questions and demonstrate that you value their time. And yes, that takes time, but it also benefits the executive summary developer of key areas needing to be addressed and what the desired outcome should be.
•  Capture real perspectives in the minutes. Document what committee members and practitioners actually said—not just "the committee discussed." Conversely, don’t go into excruciating detail so the minutes end up being 20 pages long!
•  Assign a timekeeper. Efficient meetings keep people engaged instead of checking their phones.
•  Track decisions and follow-up in logs. If someone's supposed to do something, write it down and track it.
•  Assign a quality or accreditation nurse to each committee. They become the continuity thread.
•  Audit your minutes regularly. Make sure they reflect the discussions and decisions you need to meet the standards.
•  Track attendance at meetings. I’ve heard staff say that someone doesn’t attend a meeting much, but they don’t have an attendance tracker for each committee. The committee charter and members need to decide on what would be a reasonable attendance percentage on an annual basis. If that is not being met, replace the member after the chair has the discussion with the person about their commitment to the committee. If they don’t attend, they won’t have a full picture of what is occurring. A common complaint is that it’s hard to get people to sit on committees. Keep a constant watch for those who would be a good fit. Provider relations typically knows practitioners who are really invested in the organization. Also promote committees in newsletters and in provider contacts and meetings.

Watch for Red Flags

Catching problems early prevents committees from becoming ineffective (or worse, a compliance risk).

Warning signs include:

•  Repeated absences or missing clinical leaders
•  Off-topic conversations or weak preparation
•  Stalled decisions, missing or late annual reports
•  Weak or incomplete minutes
•  Unresolved disputes
•  Unclear ownership of follow-up

If you're seeing these patterns, it's time to intervene before they become survey findings.

Final Word

A well-designed committee structure transforms compliance from a checkbox exercise into real improvement. Let your QIC set the strategic direction while your subcommittees handle the details. The payoff? Stronger compliance, better outcomes, and faster organizational progress.

Read Additional Blogs for Creating High-Impact Committees

•  Mastering NCQA Committee Minutes: Your Accreditation Lifeline
•  Credentialing Committees
•  Getting Physicians Excited About Quality

Your Next Step

Quality committees touch so many aspects of accreditation—from your survey Application to your evidence of compliance.

MHR consultants can help your organization set up the right structure and review your charters to make sure they'll hold up under scrutiny.

Looking for the basics on NCQA? 

We've got you covered:

•  MHR's "NCQA 101 Training" serves as a boot camp for anyone new to NCQA or those who need a refresher.
•  MHR's "Quality Management & Improvement" training digs into the role of a Quality Improvement Committee and how all the information flows.

To schedule a training session, visit MHR Trainings, fill out the form, and submit.

We'll contact you shortly to arrange the details.

MHR ensures quality and accuracy in every blog. This article includes insights from MHR Clinical Consultant Sheila Petras, RN, and Susan Moore, who is passionate about committees that work. Learn more about MHR's independent consultants at managedhealthcareresources.com/consultants.

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Nancy Ross Bell, RN